Can menopause cause hearing loss and tinnitus?

The decision to take hormone therapy (HT) to tame menopausal symptoms can be complex. There are benefits and risks that you must weigh with your healthcare provider. One area of emerging research is the relationship between hearing loss, menopause and hormone therapy. 

Researchers are still teasing out how menopause affects hearing. The same is true of HT: Research with mice and preliminary human studies suggest that taking estrogen can have protective effects on your hearing. However, an analysis with the largest data pool to date on the topic actually found the opposite.

If you don’t currently have hearing loss, HT could increase your risk, according to a team led by Dr. Sharon Curhan, MD, a physician and epidemiologist at Brigham and Women’s Hospital in Boston. This was true for both pills and patches, and for formulas with estrogen only or combined with progesterone.

To get down to the numbers: When Curhan’s team analyzed data for more than 47,000 female nurses spanning 22 years, they concluded that a course of HT for five to ten years increased a woman's risk of hearing loss by 15 percent compared to a woman not taking HT. 

Risk increased the longer a woman stayed on HT. The analysis also found that women who undergo menopause at an older age have a higher risk of hearing loss.

Menopause and hearing loss

It's possible that your hearing may change, or you may develop tinnitus (ringing in the ears) as you approach menopause. Why? Drops in estrogen can trigger symptoms like hot flashes. Estrogen, a hormone, plays a role throughout the body—in your muscles and bones, heart and brain as well as reproductive system. Scientists know we have estrogen receptors in ear cells and in auditory pathways, but it’s still unknown exactly how estrogen affects hearing.

Sex hormone levels change during a menstrual cycle, and during menstruation, your hearing can become less sensitive. During perimenopause—the years before your ovaries stop releasing eggs and your period ends—your ovaries gradually produce less estrogen. In the last one to two years of perimenopause, the drop in estrogen speeds up. After your period ends, typically after age 45, the ovaries produce little estrogen but you still get some from your adrenal glands and fat tissue.  

As Curhan’s team reports, both human and animal studies have shown that low estrogen levels can impair hearing, possibly through alterations in blood flow to the cochlea, the hollow tube in the inner ear. A separate study that measured hearing and blood levels of estradiol (a form of estrogen) in 1,830 post-menopausal women found that the volunteers with less estradiol were more likely to have hearing loss.

Another key reproductive hormone, progesterone, begins to drop in your thirties. Progesterone, which regulates pregnancy, is the yin to estrogen’s yang: It reduces receptor cells for estrogen. Progesterone doesn’t affect the cochlea directly but it could by reducing estrogen receptors and therefore blood flow to the ear.

Does the age when you hit menopause affect your hearing?

The link between low estrogen and impaired hearing suggests that women who arrive at menopause later, at age 50 or older—51 is the average age of menopause in the United States—might have a lower risk of hearing loss. After all, it would make sense that women who reach menopause sooner experienced earlier drops in estrogen.   

However, when Curhan’s team looked at a pool of data on nearly 81,000 nurses, the opposite was true: The women with late natural menopause surprisingly had a 10 percent higher chance of hearing loss. The reason for this finding is unclear, since we don’t have a full picture of all the factors that affect the age of menopause, Dr. Curhan told Healthy Hearing.

Monitor your hearing when starting hormone therapy

If you are about to start hormone therapy Dr. Curhan suggests monitoring your hearing and taking HT only as long as needed. Some women have reacted to HT with sudden hearing loss, tinnitus and vertigo. Contact your provider right away if this happens to you.

If you’re considering HT, you’re likely to be offered a combination with progestin (a medication like progesterone) if you still have your uterus. Estrogen alone could cause unwanted side effects, such as increasing your risk of endometrial cancer, so it's more commonly used for women who have had a hysterectomy. It should also be used with caution in women with high blood pressure (who are also at higher risk of hearing loss). 

If you do opt for HT, Dr. Curhan suggests monitoring your hearing and taking HT only as long as needed. Some people have reacted to HT with sudden hearing loss, tinnitus and vertigo. 

Perimenopause and tinnitus

The relationship between menopause, hormone replacement therapy and tinnitus is a topic that also needs more study. Some women may experience tinnitus when starting hormone therapy for perimenopause. But studies have also shown that hormone therapy can actually lower the rate of tinnitus in women who are perimenopausal. 

“We are looking forward to understanding more about risk factors for tinnitus,” Dr. Curhan told Healthy Hearing. She is studying its relation to menopause and HT.

So what can women do to protect their hearing?

Diet, exercise, and maintaining a healthy weight all count. “We found that people who ate diets that most closely resembled the Mediterranean or DASH [Dietary Approaches to Stop Hypertension] patterns had a substantially lower risk of hearing loss,” Dr. Curhan said. That means eating more fish, vegetables, and whole grains—and less meat and junk food. More: How a healthy diet helps your hearing.

Also be mindful of medications linked to hearing loss. Curhan’s research with the same big data pool found that using the over-the-counter pain-relievers ibuprofen and acetaminophen two or more times a week may be linked to hearing loss, and other studies have found similar links. There was no tie to alcohol.

Keep in mind that other conditions that can pop up for the first time in middle age—including low thyroid levels and autoimmune diseases like rheumatoid arthritis—are also linked to hearing loss, so also be sure to get regular health checkups. These conditions disproportionately affect women.

Lastly, steer clear of loud or constant background noise, get your hearing checked and wear prescribed hearing aids regularly, and you’ll know you’ve done your best to prevent hearing loss as you age.